An open public forum to debate the proposition that all males should be required to be circumcised in order to promote their own good health, the health of their sexual partners, and the public health of society.

Monday, June 7, 2010

Want to Avoid Penis Injuries During Sex? Get Circumcised!

Perhaps it's as obvious as a clean-cut penis, but still another study -- reported below by Reuters Health -- confirms more problems caused by the useless foreskin: penis injuries. Circumcised dudes are not as likely to have injuries to their male organ during sex as uncircumcised men.

To me this is pretty obvious. If you have a piece of useless skin flapping around and getting in the way of good sex (yes, there lot's of studies on that, too), it is bound to get injured -- cuts, abrasions, and minor injuries is the way the report notes it. I don't know about you but sex should never be painful, and it certainly shouldn't cause harm to your penis.

You can't help but feel sorry for these uncircumcised dudes. Not only are they at much higher risk for the transmission of HIV, HPV, STD, cancer, and the like -- but now they have to put up with a greater risk of penis injury during sex. Given all this, why would any parent allow their son to leave the hospital at birth with a filthy, disease-proned, and (now we know) injury-inducing foreskin?

Here's the full Reuters Health report:

"(Reuters Health) - A new study finds that circumcised men appear less likely to sustain cuts, abrasions and other minor injuries to the penis during sex -- which may help explain why circumcision lowers the risk of HIV transmission from heterosexual sex.

"For the new study, researchers used data from an HIV clinical trial in Africa, where nearly 2,800 men between the ages of 18 and 24 were randomly assigned to undergo circumcision or remain uncircumcised. In 2005 and 2006, that trial and two others in Uganda, South Africa and Kenya showed that circumcision can reduce a man's risk of HIV infection through heterosexual sex by up to 60 percent.

"In the current study, the researchers found that, over two years, circumcised men were 39 percent less likely than their uncircumcised counterparts to report any type of penile injuries during sex.

"This raises the possibility that lower injury risk is one reason that circumcision lowers the odds of HIV transmission, according to the researchers, led by Dr. Supriya D. Mehta of the University of Illinois at Chicago.

"Exactly why circumcision may protect against HIV during sex is unknown, Mehta and colleagues report in the Journal of Urology. There are a few theories: One is that, by reducing the amount of mucosal tissue exposed during sex, circumcision limits the virus' access to the body cells it targets. Another theory is that the thickened skin that forms around the circumcision scar helps block HIV from gaining entry.

"But there is also a possible role for mild penile injuries -- cuts, scratches and tears in the skin that could serve as a portal of entry for HIV. In some past studies, uncircumcised men have reported higher rates of such injuries than circumcised men.

"At the outset of the current trial, 64 percent of the men said they had sustained some form of penile injury during sex in the past six months -- most often general soreness, scratches, cuts or abrasions. Seventeen percent said they had bleeding.

"Six months into the trial, that rate was on the decline. By year two, 31 percent of circumcised men said they'd had a sex-related penile injury in the past six months.

"Men in the uncircumcised group also reported a reduction in injuries, though it was less significant -- with 42 percent saying they'd sustained a penile injury in the past six months. That decline, according to Mehta's team, is likely due to the general improvements both study groups showed in their sexual health practices -- including greater condom use and fewer sex partners.Men who said they had had multiple sex partners in the past month were more likely to report sex-related penile injuries than those who had been monogamous. On the other hand, condom use and the habit of washing the penis within an hour of having sex were both linked to decreased risks of penile soreness and other injuries.

"Further studies, Mehta's team writes, should look at the role penile injuries may play in the transmission of HIV or other sexually transmitted diseases."

47 comments:

For someone who claims to be an academic, you do a terrible job of citing your sources. On the internet, that means a hyperlink, not just the news source. Do you have the same lack of standards in your professional life?

When conditions are similar, so are the outcomes. Coming to the conclusion that female circumcision is inherently worse than male circumcision based on studies of operations performed by laymen in Africa is just as misleading as western doctors using these kind of examples to determine the risks of male circumcision in the US. They are both wrong and should both be illegal.

Kupelo said a 20-year-old man was arrested in the Libode area on Wednesday morning after he circumcised six other under-age youths.

Health department officials were on Wednesday afternoon preparing to rescue eight youths from an illegal circumcision school in the Ngqeleni area following information that they were ill.

Kupelo said it had emerged that a 14-year-old arrested last week for performing illegal circumcisions on his age-mates, was responsible for previous botched operations that had already resulted in nine penis amputations."

Are you seriously proposing this as a conclusion based upon the news story you quoted? Seriously? Does it not occur to you that any amateur surgery carries significant risks? Does that mean that they're all equivalent? That having a mole removed is the same as brain surgery?

The main penile injury I suffered happened when I was born. I lost about half the skin on my penis, and in its place is a large patch of scar tissue. The injury got worse as a teenager, when the scar would tend to rip, and it's really a mess now. I accept the parental choice to amputate part of my penis the same way I accept parental choice to sexually abuse me, beat me, and all those other great parental choices.

Does anyone else think that 60% of men reporting penile injuries in the six months before the study began is a remarkable proportion? Something else is going on (possibly "dry sex"). Then, six months into the trial, the non-circumcised men report a big decline in injuries - the Hawthorne effect; just going in a study makes a difference.

And though it's obscured in the reporting, the decline in injuries among the circumcised men is not much greater, 11%. So circumcising nine men might prevent one penile injury in six months. Hardly seems worth the trouble, does it?

Not only that, but the measure of all the injuries is by self-reporting, which is notoriously unreliable. Maybe getting circumcised makes men less likely to report other penile injury (just by making it look trivial in comparison.)

While the lead author is someone called Mehta, as usual, at the end of the line of authors are the familiar names of S. Moses and RC Bailey. The same tiny handful of authors are behind all the pro-circumcision studies. What a coincidence!

Come on, Hugh, be sensible. Nobody's suggesting that men should be circumcised for this reason alone.

Does anyone else think that 60% of men reporting penile injuries in the six months before the study began is a remarkable proportion? Something else is going on (possibly "dry sex").

If you consider the definition of an injury ("general soreness, scratches, cuts or abrasions"), it doesn't seem all that remarkable. If 60% of runners reported sore feet in the last 6 months I wouldn't find it surprising, so why should a sore penis be so surprising?

Then, six months into the trial, the non-circumcised men report a big decline in injuries - the Hawthorne effect; just going in a study makes a difference.

The Hawthorne effect is a behavioural response to being studied. But there's a better explanation: "That decline, according to Mehta's team, is likely due to the general improvements both study groups showed in their sexual health practices -- including greater condom use and fewer sex partners."

And though it's obscured in the reporting, the decline in injuries among the circumcised men is not much greater, 11%.

I think you need to be more specific. 11% of what?

So circumcising nine men might prevent one penile injury in six months. Hardly seems worth the trouble, does it?

I imagine it would depend on the consequences of that injury. If, as the researchers suggest, there may be a causative relationship with HIV acquisition, then preventing that injury might be very worthwhile indeed.

Not only that, but the measure of all the injuries is by self-reporting, which is notoriously unreliable. Maybe getting circumcised makes men less likely to report other penile injury (just by making it look trivial in comparison.)

Is that the best you can do? :-)

While the lead author is someone called Mehta, as usual, at the end of the line of authors are the familiar names of S. Moses and RC Bailey. The same tiny handful of authors are behind all the pro-circumcision studies. What a coincidence!

The study reports on data collected as part of the Kenyan trial, for which Robert Bailey was the lead investigator, so it should not be surprising that his name is on the paper. And since he frequently collaborates with Moses, so again, that name should not be surprising.

I am in favor of parental choice as well. I saw this story somewhere else, cannot remember where. More power to you my friend. And don't worry about those naysayers. Those African horror stories bad. They don't make circumcision bad, they make the circumciser bad. It is a mistake for any amateur to attempt a circumcision. Even the ancient tribes that practice circumcision have well established procedures.

Come on, Hugh, be sensible. Nobody's suggesting that men should be circumcised for this reason alone.

What is the headline for this item?

If 60% of runners reported sore feet in the last 6 months I wouldn't find it surprising, so why should a sore penis be so surprising?

If it's not surprising, why is anyone even thinking of cutting part of the penis off to "avoid" it? Runners take footbaths for their sore feet. Something similar seems more appropriate.

And though it's obscured in the reporting, the decline in injuries among the circumcised men is not much greater, 11%.

I think you need to be more specific. 11% of what?

11% is the absolute difference between the penile injuries among the intact and the circumcised.

that name should not be surprising.

I'm not in the least surprised. My "What a coincidence!" was of course sarcastic, nay scornful.

@Tristan: 47 Eastern Cape boys who were alive a month ago would be alive today if they had not been circumcised "to make them into men" - some contrary to their parents' wishes. That DOES make circumcision bad.

In response to: Come on, Hugh, be sensible. Nobody's suggesting that men should be circumcised for this reason alone.

What is the headline for this item?

Did you miss the word "alone"? The fact that Provoking Debate is aware of the other benefits of circumcision is surely well established.

If it's not surprising, why is anyone even thinking of cutting part of the penis off to "avoid" it?

Firstly, it seems perfectly rational to consider circumcision to take advantage of this benefit among others. By itself it is perhaps not compelling (though perhaps some might disagree with that statement), but it is worth considering together with other benefits. More information leads to better decisions, after all.

I'm not in the least surprised. My "What a coincidence!" was of course sarcastic, nay scornful.

Jake, I know you have said in the past that a reduced chance of HIV and urinary infections is something that almost all men would want, and therefore circumcision is valid in your perspective.

However, if that were the case, you wouldn't see smokers and other tobacco users. Tobacco related cancers and deaths are the number one most preventable deaths in the United States. Anyone who smokes knows the risks. No one is shoving cigarettes down their throats and forcing them to inhale. They value the pleasure of the cigarettes over the risks of lung and other organ cancers. Suffice to say, slowly suffocating to death from lung cancer is a horrible way to die, no one can debate that.

Just recently a vaccine that might stop current and future smokers from becoming addicted has been under development.

"Nicotine is a small molecule that upon inhalation into the lungs quickly passes into the bloodstream and subsequently reaches the brain by crossing the blood-brain barrier. Once in the brain, the nicotine binds to specific nicotine receptors resulting in the release of stimulants, such as dopamine, a chemical linked to pleasure and to addiction. NicVAX is designed to stimulate the immune system to produce antibodies that bind to nicotine in the bloodstream and prevent it from crossing the blood-brain barrier and entering the brain. With a reduced amount of nicotine reaching the brain, fewer stimulants are released and the pleasurable, positive-reinforcing effects of nicotine are diminished, thereby making it easier to quit smoking. Pre-clinical studies with NicVAX have shown that vaccination prevents nicotine from reaching the brain and blocks the effects of nicotine, including effects that can lead to addiction or can reinforce and maintain addiction, in animals. "

Very soon after the press release many legal experts stated that it would almost certainly be illegal to administer this vaccine to infants and children because it would take away their right to enjoy nicotine and cigarettes if they so choose. Even though it would save hundreds of thousands of lives.

The same principal applies to circumcision as well. Especially because there are other ways to reduce your chance or treat conditions that circumcision is allegedly meant to prevent.

Jake, I know you have said in the past that a reduced chance of HIV and urinary infections is something that almost all men would want, and therefore circumcision is valid in your perspective.

Um, no, I don't believe I'd have put it like that.

Certainly, I think it's fair to say that the reduction in risk of HIV and UTIs (and other conditions) is likely to be considered more or less universally to be a benefit.

However, it doesn't necessarily follow directly from that that circumcision is desirable. By analogy, consider the following. Foot amputation would, almost certainly, reduce the risk of athlete's foot. Furthermore, it seems likely that this risk reduction would be considered a benefit by all. However, it would be an error to conclude that foot amputation is desirable, because such a conclusion can only be made once the benefits are weighed against harms.

Having studied the issue at length, it is clear to me that neonatal circumcision is acceptable because there is no net harm. That is, although there's dispute among serious observers about whether it is neutral or beneficial on balance, it isn't harmful, so it is a reasonable choice for parents to make on behalf of their sons.

Glad to see the new US HIV/AIDS strategy outlined today by the White House:

" ... It highlights the need to steer federal grant money toward organizations dealing with high-risk groups such as gay and bisexual men and illegal substance users."

Precisely the groups of individuals that don't benefit from circumcision-

"...It also cites the importance of greater education and "scientifically proven biomedical and behavioral approaches" to reduce the spread of the disease, including the use of condoms, abstinence, HIV testing, and access to sterile needles and syringes."

No mention of circumcision here- or anywhere else in the press release. All good news!

Although it doesn't necessarily mean they aren't going to use it as a tool at all- it doesn't seem like a very high priority, or something they feel would make a very big impact.

Increasing the amount of people getting tested, condom education, and sterile needles are all proven and cost effective means of reducing the spread of HIV. Good job!

Oh and this is some good news....

"The White House announcement came less than a week after a group of scientists published a study saying they had made a key discovery that could help in the development of an HIV vaccine.Scientists at the National Institute of Allergy and Infectious Diseases said last week that they had found three human antibodies that neutralize more than 90 percent of the current circulating HIV-1 strains."This is significant because we've now found antibodies that are good templates for HIV vaccine development," said Peter Kwong, co-author of the study published last Thursday in the journal Science."

A study presented at the AIDS conference determining what percentage of men would be willing to get circumcised for a reduced chance of HIV:

"The study was based on surveys of 521 gay and bisexual men in San Francisco. Findings indicated that 115 men (21 percent) were HIV-positive and 327 (63 percent) had been circumcised. Of the remaining 69 men (13 percent), only three (0.5 percent) said they would be willing to participate in a clinical trial of circumcision and HIV prevention, and only four (0.7 percent) were willing to get circumcised if it was proven safe and effective in preventing HIV.The researchers extrapolated these findings to the entire gay and bisexual male population of San Francisco, an estimated 65,700 people, and determined that only 500 men would potentially benefit from circumcision.

"Our study indicates that any potential benefit may likely be too small to justify implementing circumcision programs as an intervention for HIV prevention."

Of course you'll hear the likes of advocates like Jake say that this is the reason it should be done in infancy... but when applied to any other surgery this argument doesn't hold water.

NEW STUDY! ONLY 1 PERCENT OF WOMEN WOULD BE WILLING TO CUT OFF THEIR BREASTS TO REDUCE THEIR CHANCE OF GETTING BREAST CANCER BY UP TO 99 PERCENT. THEREFORE, IT CAN ONLY BE CONCLUDED THAT IT SHOULD BE FORCED ON THEM AT INFANCY!

Many men LIKE their foreskins. Being uncircumcised is considered a good thing in the gay community here in the US. Foreskin fetishes are extremely common in the US gay circle.

I am not sure why some circumcision advocates like PD say "foreskin fetishists" like it's some dirty horrible thing. What's the difference between a foreskin and any other body part? Breasts, legs, feet etc?

The researchers extrapolated these findings to the entire gay and bisexual male population of San Francisco, an estimated 65,700 people, and determined that only 500 men would potentially benefit from circumcision.

This extrapolation seems rather questionable to me. Other studies have shown acceptability of circumcision at 60-80%; extrapolating from an anomaly seems unwise.

Of course you'll hear the likes of advocates like Jake say that this is the reason it should be done in infancy...

God, the Anti-Circ crowd really annoys me...For christs sake, I got circumcised a few years ago. No big deal... Of course I'm probably "in denial". What you need to understand is that in reality, the anti circs are a MINORITY in the real world. They are only known of on the internet, and most people find satire in their pages.

"What you need to understand is that in reality, the anti circs are a MINORITY in the real world. They are only known of on the internet, and most people find satire in their pages."

Anti adult "circs" are most likely in the minority- but I don't know anyone who is opposed to an adult choosing surgery for themselves.

What "anti circs" are against is imposing it on infants that cannot consent. Indeed, the vast majority of countries are non infant circumcising ones, American is in the vast minority on that one.

I think you would find while travelling to European countries looks of shock and horror if you were to ask an expectant mother whether or not she is circumcising her son, assuming she isn't Jewish. You get replies like "Why on earth would I do that?" - even more so outside of England.

You don't see or hear of people in non circumcising countries talking about it online as much because it isn't an issue there, it only gets done for religious or medical reasons.

What "anti circs" are against is imposing it on infants that cannot consent. Indeed, the vast majority of countries are non infant circumcising ones, American is in the vast minority on that one.

The mistake you're making here is failing to distinguish between doing (or not doing) something and having a certain attitude towards it. The distinction is an important one — for example, consider the difference between stating that 20% of the world's population don't have running water, and stating that 20% of the world's population are opposed to running water.

Clearly there is a very significant difference between the two, and it is not rational to infer one from the other.

I think you would find while travelling to European countries looks of shock and horror if you were to ask an expectant mother whether or not she is circumcising her son, assuming she isn't Jewish. You get replies like "Why on earth would I do that?" - even more so outside of England.

While it's amusing to watch you speculate (and frankly it's almost always funny to watch anti-circumcision activists present their guesses as fact), let me at least give you the chance...

What evidence do you have in support of this claim? For example, do you have polls of European countries (which countries?) in which the person performing the poll recorded facial expressions? Can you cite any of these polls?

"What evidence do you have in support of this claim? For example, do you have polls of European countries (which countries?) in which the person performing the poll recorded facial expressions? Can you cite any of these polls?"

Much like your evidence that adult circumcision has poorer results and increasing scarring, it is from mine and my husband's observation while living there. He was still adament about circumcising our son, and when he brought it up he would get lectures and looks of shock.

I urge you to walk into a hospital in the Netherlands and other European countries and see for yourself.

"The mistake you're making here is failing to distinguish between doing (or not doing) something and having a certain attitude towards it. The distinction is an important one — for example, consider the difference between stating that 20% of the world's population don't have running water, and stating that 20% of the world's population are opposed to running water."

Of course that analogy is ridiculous. If a person isn't drinking running water because they don't have any that is a very different than having access to running water and then choosing not to drink it.

With very few exceptions, a parent can choose to circumcise their son at birth in a hospital if they wish. An adult can also choose to get circumcised if he wishes as well. And as a recent poll presented by the CDC at the AIDS conference showed, very very few adult men would choose to get circumcised even if the procedure was proven safe and effective at preventing HIV.

"You think so, do you? Name five hospitals in the UK which offer neonatal circumcision."

http://www.020.co.uk/c/circumcision/london.shtml

You can find a surgeon or registered Mohel in England. Many parents in the US prefer Mohels to hospitals and I have yet to see a Mohel refuse to circumcise a baby simply because they are not Jewish. See actress Sandra Bullock for a recent provable example.

"Indeed. So how can we tell which is which if all the information we have is that they don't drink it?"

That isn't all the information we have. It is very simple with access to the internet to see in which countries circumcision is illegal. It is very rare for infant circumcision to be illegal when performed by a registered Mohel or surgeon/urologist.

"For considerable expense, and time off work/school, and from sexual activity, yes. These aren't trivial obstacles."

Of course. As do breast implants, tummy tucks, nose jobs, liposuctions, vagioplasties and planned voluntary c- sections. Unless you are implying that none of those surgeries require time off work/school and considerable money. No surgery is painless and that is a factor that has to be weighed in for any adult considering voluntary surgery. Circumcision is no exception.

"Cherry-picking anomalous studies is fun, I'm sure, but we need to remain grounded in the real world. And most studies have shown that the acceptability of circumcision is quite high. See, for example:"

The only one of those conducted in the USsays "Willingness was associated with... perceived reduced risk of penile cancer (OR: 4.7, 95% CI: 2.0-11.9). " Since that is not a fact that has been established and is contradictory to what the American Cancer Society has concluded about adult circumcision and penile cancer, I think its safe to say that study is most likely inaccurate and, at the very least, needs to be redone.

The rest were not in the US and the results were strongly influenced by the perceived notion that circumcision= better hygiene. That also is not a fact as the AAP has concluded "there is little evidence to affirm the association between circumcision status and optimal penile hygiene".

[In reply to:] "You think so, do you? Name five hospitals in the UK which offer neonatal circumcision."

http://www.020.co.uk/c/circumcision/london.shtml

You haven't answered my question. Your claim was that "With very few exceptions, a parent can choose to circumcise their son at birth in a hospital if they wish." So, what hospitals offer this service?

You can find a surgeon or registered Mohel in England. Many parents in the US prefer Mohels to hospitals and I have yet to see a Mohel refuse to circumcise a baby simply because they are not Jewish. See actress Sandra Bullock for a recent provable example.

Interestingly, one mother I know actually had to fly to London from Scotland to have her son circumcised, since she couldn't find anyone nearer.

That isn't all the information we have. It is very simple with access to the internet to see in which countries circumcision is illegal. It is very rare for infant circumcision to be illegal when performed by a registered Mohel or surgeon/urologist.

Now you're failing to distinguish between "legal" and "readily available".

Of course. As do breast implants, tummy tucks, nose jobs, liposuctions, vagioplasties and planned voluntary c- sections. Unless you are implying that none of those surgeries require time off work/school and considerable money. No surgery is painless and that is a factor that has to be weighed in for any adult considering voluntary surgery. Circumcision is no exception.

Quite. So it's an error to assume that anyone who would wish to be circumcised is already circumcised.

The only one of those conducted in the USsays "Willingness was associated with... perceived reduced risk of penile cancer (OR: 4.7, 95% CI: 2.0-11.9). Since that is not a fact that has been established and is contradictory to what the American Cancer Society has concluded about adult circumcision and penile cancer, I think its safe to say that study is most likely inaccurate and, at the very least, needs to be redone. "

You're making two mistakes here.

The first mistake is to fail to distinguish between whether they wish to be circumcised (which is what we're discussing) and whether you personally agree with their understanding of circumcision. We're not discussing the latter, and I'm sorry to be blunt but it doesn't matter.

The second mistake is to assume that this is the only reason why men would consider being circumcised. If you read the full text of the study, you'll find that "MSM who were willing to be circumcised were more likely to report that they agreed that circumcision might increase sexual pleasure (OR: 3.6; 95% CI: 1.5–8.8), increase hygiene (OR: 3.0; 95% CI: 1.3–6.8), reduce risk of penile cancer (OR: 4.7; 95% CI: 2.1–10.8), and reduce risk of STDs (OR: 5.3; 95% CI: 2.3–12.5)."

The rest were not in the US

True, but irrelevant.

and the results were strongly influenced by the perceived notion that circumcision= better hygiene. That also is not a fact as the AAP has concluded "there is little evidence to affirm the association between circumcision status and optimal penile hygiene".

Again, you're making the mistake of assuming that your opinion has any relevance here. It doesn't. We're discussing whether men wish to be circumcised, not whether men with to be circumcised for reasons that meet with your personal approval.

STILL WAITING. Please provide proof that you were cut at 18, mike. And the phrase "university academic" suggests you clean the bathrooms at moody bible college. What is your doctorate in and where can we find what your have published?

Look Jake! Finally a new study just released by the AMA on mastectomies!

"(Reuters) - Women with mutations in the well-known BRCA1 or BRCA2 genes who have their breasts and ovaries removed are much more likely to survive than women who do not get preventive surgery, U.S. researchers said on Tuesday.The study shows the benefits of genetic tests that give women with a family history of cancer the chance to take steps to increase their chances of survival, they said.

"This is the first study to prove women survive longer with these preventive surgeries and shows the importance of genetic testing when there is a family history of early breast or ovarian cancer," Dr. Virginia Kaklamani of Northwestern University in Chicago wrote in a commentary about the study published in the Journal of the American Medical Association.

Women with mutations in the BRCA1 or BRCA2 genes have a 56 to 84 percent higher risk of developing breast cancer during their lifetimes.

Those with the BRCA1 mutation also have a 36 to 63 percent higher risk of ovarian cancer and those with the BRCA2 mutation have a 10 to 27 percent higher risk of ovarian cancer.

Because of this, many women make the difficult choice to have their breasts or ovaries and fallopian tubes surgically removed to reduce their risk.

Dr. Susan M. Domchek of the University of Pennsylvania School of Medicine in Philadelphia and colleagues studied the effectiveness of these procedures, comparing rates of cancer and death in 2,482 women who had the surgery with those who decided against it in favor of frequent cancer screenings.

No woman who had a mastectomy developed breast cancer during the three years of follow-up testing.

Seven percent of women who decided against a mastectomy were diagnosed with breast cancer in the same period.

"Our results confirm that risk-reducing mastectomy is associated with a significant reduction in breast cancer risk," Domchek and colleagues wrote.

Women with BRCA1 and BRCA2 mutations who had their ovaries and fallopian tubes removed had similar results.

About 10 to 20 percent of breast and ovarian cancers are due to BRCA1 or BRCA2 genes. "Most of these women will die of ovarian cancer, so you can save 20 percent of them with the prophylactic surgery," Kaklamani said.

"And you can save the majority of women who would have died of their breast cancer," she added."

Guess we should genetically test all infant girls and chop those breasts and ovaries!

Another bit from the CNN article :

"In addition, the women who had an ovary and fallopian tube removed cut their risk of dying from ovarian and breast cancer by 79 percent and 56 percent, respectively.The findings confirm "an incredibly important endpoint," says Claudine Issacs, M.D., one of the study researchers and the medical director of cancer assessment and risk evaluation at Georgetown Lombardi Comprehensive Cancer Center, in Washington, D.C."If you have this preventive surgery, it not only decreases the risk of disease *but also significantly decreases the risk of death*, which is [the] most important thing you're trying to do."

It would MEASURABLY decrease the chance of death. Something circumcision has not been proven to do in the US.

Look Jake! Finally a new study just released by the AMA on mastectomies!

"(Reuters) - Women with mutations in the well-known BRCA1 or BRCA2 genes who have their breasts and ovaries removed are much more likely to survive than women who do not get preventive surgery, U.S. researchers said on Tuesday.The study shows the benefits of genetic tests that give women with a family history of cancer the chance to take steps to increase their chances of survival, they said.

"This is the first study to prove women survive longer with these preventive surgeries and shows the importance of genetic testing when there is a family history of early breast or ovarian cancer," Dr. Virginia Kaklamani of Northwestern University in Chicago wrote in a commentary about the study published in the Journal of the American Medical Association.

Women with mutations in the BRCA1 or BRCA2 genes have a 56 to 84 percent higher risk of developing breast cancer during their lifetimes.

Those with the BRCA1 mutation also have a 36 to 63 percent higher risk of ovarian cancer and those with the BRCA2 mutation have a 10 to 27 percent higher risk of ovarian cancer.

Because of this, many women make the difficult choice to have their breasts or ovaries and fallopian tubes surgically removed to reduce their risk.

Dr. Susan M. Domchek of the University of Pennsylvania School of Medicine in Philadelphia and colleagues studied the effectiveness of these procedures, comparing rates of cancer and death in 2,482 women who had the surgery with those who decided against it in favor of frequent cancer screenings.

No woman who had a mastectomy developed breast cancer during the three years of follow-up testing.

Seven percent of women who decided against a mastectomy were diagnosed with breast cancer in the same period.

"Our results confirm that risk-reducing mastectomy is associated with a significant reduction in breast cancer risk," Domchek and colleagues wrote.

Women with BRCA1 and BRCA2 mutations who had their ovaries and fallopian tubes removed had similar results.

About 10 to 20 percent of breast and ovarian cancers are due to BRCA1 or BRCA2 genes. "Most of these women will die of ovarian cancer, so you can save 20 percent of them with the prophylactic surgery," Kaklamani said.

"And you can save the majority of women who would have died of their breast cancer," she added."

Guess we should genetically test all infant girls and chop those breasts and ovaries!

Another bit from the CNN article :

The findings confirm "an incredibly important endpoint," "If you have this preventive surgery, it not only decreases the risk of disease *but also significantly decreases the risk of death*, which is [the] most important thing you're trying to do."

It would MEASURABLY decrease the chance of death. Something circumcision has not been proven to do in the US.

Look Jake! Finally a new study just released by the AMA on mastectomies!

"(Reuters) - Women with mutations in the well-known BRCA1 or BRCA2 genes who have their breasts and ovaries removed are much more likely to survive than women who do not get preventive surgery, U.S. researchers said on Tuesday.The study shows the benefits of genetic tests that give women with a family history of cancer the chance to take steps to increase their chances of survival, they said.

"This is the first study to prove women survive longer with these preventive surgeries and shows the importance of genetic testing when there is a family history of early breast or ovarian cancer," Dr. Virginia Kaklamani of Northwestern University in Chicago wrote in a commentary about the study published in the Journal of the American Medical Association.

Women with mutations in the BRCA1 or BRCA2 genes have a 56 to 84 percent higher risk of developing breast cancer during their lifetimes.

Those with the BRCA1 mutation also have a 36 to 63 percent higher risk of ovarian cancer and those with the BRCA2 mutation have a 10 to 27 percent higher risk of ovarian cancer.

Because of this, many women make the difficult choice to have their breasts or ovaries and fallopian tubes surgically removed to reduce their risk.

Dr. Susan M. Domchek of the University of Pennsylvania School of Medicine in Philadelphia and colleagues studied the effectiveness of these procedures, comparing rates of cancer and death in 2,482 women who had the surgery with those who decided against it in favor of frequent cancer screenings.

No woman who had a mastectomy developed breast cancer during the three years of follow-up testing.

Seven percent of women who decided against a mastectomy were diagnosed with breast cancer in the same period.

"Our results confirm that risk-reducing mastectomy is associated with a significant reduction in breast cancer risk," Domchek and colleagues wrote.

Women with BRCA1 and BRCA2 mutations who had their ovaries and fallopian tubes removed had similar results.

About 10 to 20 percent of breast and ovarian cancers are due to BRCA1 or BRCA2 genes. "Most of these women will die of ovarian cancer, so you can save 20 percent of them with the prophylactic surgery," Kaklamani said.

"And you can save the majority of women who would have died of their breast cancer," she added."

Guess we should genetically test all infant girls and chop those breasts and ovaries!

The findings confirm "an incredibly important endpoint," "If you have this preventive surgery, it not only decreases the risk of disease *but also significantly decreases the risk of death*, which is [the] most important thing you're trying to do."

It would MEASURABLY decrease the chance of death. Something circumcision has not been proven to do in the US.

ie: it has not been shown that circumcised men live any longer in the US than intact men do.

Yes, the article does appear to indicate that such surgery has benefits for the relevant subset of women (ie., those with these particular genetic markers).

Returning to the subject:

ie: it has not been shown that circumcised men live any longer in the US than intact men do.

It's a trivial application of elementary logic: it has been proven to reduce the risk of certain diseases, and several of those diseases are known to be fatal in a certain fraction of cases. If you refuse to apply elementary logic, fair enough, that's your prerogative...

"Yes, the article does appear to indicate that such surgery has benefits for the relevant subset of women (ie., those with these particular genetic markers)."

So then you advocate cutting of breasts/removing ovaries of children with the genetic marker? Also, only 10 percent of breast cancers are linked to that genetic marker so I don't see how one can justify not cutting the breasts of *all* girls. An average woman who does not have the genetic marker is still significantly more likely to die of breast cancer than any heterosexual man is to die of HIV/AIDS.

"It's a trivial application of elementary logic: it has been proven to reduce the risk of certain diseases, and several of those diseases are known to be fatal in a certain fraction of cases. If you refuse to apply elementary logic, fair enough, that's your prerogative..."

Except the probability of a heterosexual man getting HIV/AIDS from vaginal sex in the US is so minuscule that the life expectancy difference has not been shown to be statistically significant in any measurable way.

Jake saidIt's a trivial application of elementary logic: it has been proven to reduce the risk of certain diseases, and several of those diseases are known to be fatal in a certain fraction of cases. If you refuse to apply elementary logic, fair enough, that's your prerogative...

Actually, you are wrong, and there are many cases where your notion of elementary logic doesn't work. For example, there have been some novel cancer drugs that caused tumors to shrink, but paradoxically they didn't significantly extend life expectancy. That's why they have to be tested to gain approval. Where are the studies showing that intact men have shorter life expectancies?

So then you advocate cutting of breasts/removing ovaries of children with the genetic marker?

Actually, I'm not going to advocate anything based on a brief skimming of a news article. :-)

Also, only 10 percent of breast cancers are linked to that genetic marker so I don't see how one can justify not cutting the breasts of *all* girls.

That seems a little hasty. First, the benefit hasn't been established in all girls, but only in this subset. Second, the benefit has to be weighed against the harm, and this comparison varies with circumstance.

Actually, you are wrong, and there are many cases where your notion of elementary logic doesn't work.

It's necessary to take account of harms as well as benefits, but since the risks associated with neonatal circumcision are so few, we can safely discount them.

Jake said:"it (male circumcision) has been proven to reduce the risk of certain diseases..."

The benefits of male circumcision has been proven in studies, but has it been proven in everday life? Take a look at the comparison between Israel, USA and Germany. Please explain, where can we see the proven benefits of male circumcision?I'm sorry for the bad layout!

Safely discount them from what? It would make as much sense to say that the benefits of circumcision are small - they are - and can be safely discounted. None of this matters as to the question: do circumcised men live longer? Maybe circumcised men have more varied sexual practices than intact men, get more diseases, and die sooner. Where are the studies showing that circumcised men live longer?

The benefits of male circumcision has been proven in studies, but has it been proven in everday life? Take a look at the comparison between Israel, USA and Germany. Please explain, where can we see the proven benefits of male circumcision?

I can't see how it would be possible to see proven benefits of anything through such a comparison. A fundamental principle in science is to isolate the effect of what you wish to measure. But circumcision is just one of many differences between these countries, so there's no isolation and hence one can't draw any sensible conclusions about any single difference.

Where are the studies showing that circumcised men live longer?

Asking the same question over and over again is a little pointless, don't you think?

Jake said:I can't see how it would be possible to see proven benefits of anything through such a comparison.

You can't see anything? Why did you write the following sentence:"If all males were circumcised, we would see a reduction in HIV..."Here again: the prevalence of HIV Prevalence of HIV(per 1,000 adults 15-49 years)Israel[1] 1USA[2] 6Germany[3] 1

Jake said:But circumcision is just one of many differences between these countries, so there's no isolation and hence one can't draw any sensible conclusions about any single difference.

But one can draw worldwide valid conclusions from studies, which were made in Africa? What about the differences between european and african countries? In 2008 the german Aerzteblatt[1] published an article about circumcision and you can read there: "Whether these results (of the african studies)are transferable to other countries is highly questionable"[2].

Why does UNAIDS compare the HIV prevalence in different countries?[3]Have you read one of the PDFs, which I listed above? Do it! Look at the table 'Selected Indicators' and explain the columns 'regional average' and 'global average'.

A comparison is a form of measurement (though, as I pointed out, not a good one). If you're not making the comparison to determine the effect of circumcision, why are you doing it?

But one can draw worldwide valid conclusions from studies, which were made in Africa?

Yes. There's nothing inherently wrong with Africa, and there's no reason why a study performed in Africa should not be valid.

What about the differences between european and african countries?

It would be invalid to draw conclusions about the effect of circumcision based upon those.

In 2008 the german Aerzteblatt[1] published an article about circumcision and you can read there: "Whether these results (of the african studies)are transferable to other countries is highly questionable"[2].

You haven't provided footnotes to allow me to follow the references. Ultimately Aerzteblatt is entitled to his/her opinion, but I firmly disagree.

Why does UNAIDS compare the HIV prevalence in different countries?[3]Have you read one of the PDFs, which I listed above? Do it! Look at the table 'Selected Indicators' and explain the columns 'regional average' and 'global average'.

Again, you haven't provided any footnotes, so I don't know what references you're trying to cite. Anyway, the question is, do they make a statement of the following form:

The rate of HIV is low in country X and the rate of Y is high. In contrast, the rate of HIV is high in country Z and the rate of Y is low. Therefore...?

If so, we're talking about the same kind of comparison. If, however, they discuss different rates without trying to use these to prove or disprove the effect of a single risk factor, then it is not.

"If you have a piece of useless skin flapping around and getting in the way of good sex (yes, there lot's of studies on that, too)"

I'm interested in references, coz I have never heard of those.

"You can't help but feel sorry for these uncircumcised dudes. Not only are they at much higher risk for the transmission of HIV, HPV, STD, cancer"

So that's why uncut men have much higher rates of STDs? OH WAIT THEY HAVE NOT.Studies from australia, new zealand, britain and even USA have proven it.I think you are just insecure about your weiner and want to give you a sense of superiority. It's cute in a way.

"There's nothing inherently wrong with Africa, and there's no reason why a study performed in Africa should not be valid."

What if washing your di*k with clean water after sex had the same effect as being circumcised?It makes sense and could be one reason why results from africa can't be extrapolated to developped countries. But you may be to busy rationalizing to see that.

Circumcision is no longer recommended by ANY major health organization in the world, it increases some risks and decreases the others so the benefits are a mixed bag, on the other hand the sexual drawbacks are going to be there no matter what.

The foreskin contains more nerve endings than any other part of the penis, that's just fact. "In the largest study on circumcision in South Korea, Seoul University found 33% of men who were circumcised reported difficulty attaining sexual gratification, 63% said masturbation less enjoyable, and 11% had "frequent" orgasm difficulties.(Kim, Peng et all, Seoul University)"